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MAYA FE NG-DARJUAN, MD-RN. ◦ Neoplastic disorder that can involve all body organs ◦ Cells lose their normal growth-controlling mechanism ◦ Growth of.

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Presentation on theme: "MAYA FE NG-DARJUAN, MD-RN. ◦ Neoplastic disorder that can involve all body organs ◦ Cells lose their normal growth-controlling mechanism ◦ Growth of."— Presentation transcript:

1 MAYA FE NG-DARJUAN, MD-RN

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3 ◦ Neoplastic disorder that can involve all body organs ◦ Cells lose their normal growth-controlling mechanism ◦ Growth of cells uncontrolled

4 MAYA FE NG-DARJUAN MD- RN Contact inhibition Suppresor gene via Contact inhibition and Suppresor gene

5 MAYA FE NG-DARJUAN MD- RN Source: Core Curriculum for Oncology Nursing (Itano and Taoka) CELL CYCLE Go – Resting phase Restriction checkpoint 8hrs or more 6-8 hrs 2-5 hrs

6 PARTS OF A CELL

7 MAYA FE NG-DARJUAN MD- RN Source: Core Curriculum for Oncology Nursing (Itano and Taoka) Normal Cell DNA Damage Mutations in the genome of somatic cells Alteration of genes that regulates apoptosis Expression of altered gene products Loss of regulatory gene product MALIGNANT NEOPLASM Activation of growth promoting oncogene Inactivation of cancer suppresssor genes Acquired (environmental DNA damaging agents) Chemicals Radiation viruses Successful DNA repair Failure of DNA repair Clonal expansion Additional mutations Heterogeneity CARCINOGENESIS

8  Clinical Staging ◦ 0: cancer in situ ◦ 1: tumor limited to tissue of origin ◦ 2: limited local spread ◦ 3: extensive local and regional spread ◦ 4: metastasis

9  TNM Classification ◦ Tumor size ◦ Spread to lymph nodes ◦ Metastasis

10  Reduce or avoid exposure to known or suspected carcinogens  Eat balanced diet  Exercise regularly  Adequate rest  Health examination on a regular basis

11  Eliminate, reduce, or change perceptions of stressors and enhance ability to cope  Enjoy consistent periods of relaxation and leisure  Know 7 warning signs of cancer  Self-examination  Seek medical care if cancer is suspected

12  Patient may experience fear and anxiety  Clear and repeated explanations may be necessary  Diagnostic plan includes ◦ Health history (emphasis on risk factors) ◦ Physical exam ◦ Specific studies

13  Biopsy - involves histologic examination by a pathologist of a piece of tissue  Imaging techniques – CT scan, MRI, UTZ  Laboratory test and tumor markers.

14  SURGERY  CHEMOTHERAPY  RADIOTHERAPY  IMMUNOMODULATION  BONE MARROW TRANSPLANT

15  Goal is to reduce number of cancer cells in the tumor site(s) ◦ Directed to cells with high mitotic index Main problem: ◦ Cancer cells can escape death by staying in the G 0 phase ◦ drug- resistant

16  Cell-cycle Nonspecific (CCNS) ◦ Alkylating agents - CYCLOPHOSPHAMIDE ◦ Antitumor antibiotics - DOXORUBICIN ◦ Hormones - CORTICOSTEROIDS  Cell specific (CCS) ◦ Antimetabolites – FLOUROURACIL ◦ Mitotic inhibitors – VINCA ALKALOIDS

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18  Oral  IM  IV  Intracavitary  Intrathecal  Intraarterial  Continuous infusion  Subcutaneous  Topical

19 causing cross- linking of DNA strands Cell cycle-nonspecific (CCNS) Cell cycle-nonspecific (CCNS)

20 ALKYLATING AGENTS 1. Busulfan (myleran) 2. Carboplatin (Paraplatin) 3. Carnustine ( BCNU) 4. Chlorambucil ( Leukeran) 5. Cisplatin ( Platinol AQ) 6. Cyclophosphamide ( Cytoxan) 7. Ifosfamide ( (Ifex) 8. Lomustine ( CCNU) 9. Melphalan ( Alkeran) 10. Streptozocin ( Zanosar) 11. Temozolamide ( Temodar)

21 acts like a natural metabolite thus disrupting cancer metabolic processes CCS – S phase

22 ANTIMETABOLITES 1. Capecitabine ( Xeloda) 2. Cladribine ( Leustatin) 3. Clofarabine ( Clolar) 4. Cytarabine Hcl ( Cytosar) 5. Fludarabine ( Fludara) 6. Fluorouracil ( 5-FU) 7. Gemcitabine ( gemzar) 8. Mercaptopurine ( 6-MP, Purinethol) 9. Methotrexate ( MTX) 10. Thiohuanine ( TG, Tabloid)

23 SIDE EFFECTS same as alkylating agents Bone marrow depression Infection Bleeding anemia GI disturbance hemorrhagic cystitis Skin – stomatitis, alopecia

24 MOA: Block the formation of the mitotic spindle during mitosis, thus inhibiting cell division Cell cycle specific agentsCell cycle specific agents PERIWINKLE PLANT

25 PERIWINKLE PLANT NATURAL PRODUCTS 1. Etoposide ( Ve Pesid) 2. Docetaxel ( Taxoterel) 3. Paclitaxel ( Taxol) 4. Vinblastine sulfate ( Velban) 5. Vincristine sulfate ( Oncovir) 6. Vinorelbine ( Navelbine)

26 MOA: Bind to DNA, inhibiting DNA or RNA synthesis, eventually inhibits protein synthesis, preventing cell replication CCNS

27 ANTIBIOTICS 1. Daunorubicin ( Cerubidine) 2. Doxorubicin ( Adriamycin) 3. Epirubicin ( Ellence) 4. Idarubicin ( Idamycin) 5. Mitomycin C ( Mutamycin) 6. Mitoxantrone ( Novantrone) 7. Valrubin ( valstar)

28 Note: Doxurubicin Doxurubicin is cardiotoxic

29 1. CORTICOSTEROIDS – anti- inflammatory 2. HORMONE a.ESTROGEN – retards prostate cancer b.PROGESTINS – retards breast and uterine cancer c.TAMOXIFEN – synthetic anti-estrogen,

30 DRUGINDICATIONS 1. AMIFOSTINE( Ethyol) Reduce cumulative toxicity associated with repeated administration of CISPLATIN in patients with advanced ovarian cancer 2. DEXRAZOXANE ( Zinecard) Reduce the incidence and severity of cardiomyopathy associated with DOXORUBICIN in women with metastatic breast cancer. 3. MESNA( Mesnex)Reduce the incidence of IFOSFAMIDE and CYCLOPHOSPHAMIDE induced hemorrhagic cystitis

31  Chemotherapeutic agents cannot distinguish between normal and cancer cells  Body’s response to products of cellular destruction in circulation may cause fatigue, anorexia, and taste alterations

32  Acute toxicity ◦ Vomiting ◦ Allergic reactions ◦ Arrhythmias  Delayed effects ◦ Mucositis ◦ Alopecia ◦ Bone marrow suppression

33  Chronic toxicities ◦ Damage to  Heart  Kidney  Liver  Lungs

34 SIDE EFFECTS: Bone marrow depression Infection Bleeding anemia GI disturbance hemorrhagic cystitis Skin – stomatitis, alopecia

35 CLIENT TEACHINGS Take drug in the day – prevent drug accumulation at night Excreted in breast milk Reversible oligospermia – sperm bank

36 CLIENT TEACHINGS Avoid pregnancy for 3-4 mos Protective isolation Good oral hygiene – soft bristled toothbrush Recommend wig, head scarf Low purine diet – organ meats, beans and peas - alkalinize the urine Smal Small frequent meals

37  Drugs usually given in combination ◦ synergistic efffects ◦ CCNS and CCS combination ◦ note: combined side effects also  Carefully calculated according to body weight or body surface area

38  Must differentiate between tolerable side effects and toxic side effects  Serious reactions must be reported ◦ Some toxicities are not reversible

39  Administration of antiemetic drugs  Monitor lab results, particularly WBCs, platelet, and RBCs ◦ Assess for signs of bleeding if platelet count falls below 50,000/μl

40  Patient must be told what to expect to decrease anxiety  Encourage discussion of fears  Reassure patient that situation is only temporary  Inform patient of supportive care that will be provided

41  Risk for leukemias and other secondary malignancies resulting from therapy  Secondary malignancies have been reported fibrosarcomas ◦ Includes breast, ovarian, uterine, thyroid, and lung cancers, fibrosarcomas

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44 1. A client is scheduled to receive doxorubicin (Adriamycin) as part of his treatment for cancer. You note in his medical record that he is taking a calcium channel blocker (e.g., verapamil). As the nurse you will monitor closely the client because: A. doxorubicin decreases the effectiveness of verapamil. B. doxorubicin increases the toxicity of verapamil. C. calcium channel blockers increase the risk of cardiac toxicity. D. calcium channel blockers decrease the risk of cardiac toxicity.

45 Answer: C

46 Your client is scheduled to receive fluorouracil (5-FU) to treat colon cancer. Which of the following statements made by your client indicates a need for additional teaching about 5-FU? A.“I should call the physician if I develop signs of infection.” B.“I should examine my mouth occasionally for soreness or ulceration.” C.“I should not visit anyone who has the flu or a cold.” outsid D.“I should use sunscreen when I go outside during the daylight.”

47 Answer: B

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